Life · 3 authors, 4 centres
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This case series of three patients with complex corneal disorders describes how in-vivo confocal microscopy (IVCM) improved diagnostic precision and guided treatment adjustments in cases of Acanthamoeba keratitis, fungal keratitis in an immunosuppressed patient, and severe dry eye disease with Sjögren's syndrome.
Three patients with complex corneal disorders at a single institution were evaluated using in-vivo confocal microscopy (IVCM). Case one involved a 36-year-old contact lens wearer with suspected Acanthamoeba keratitis in whom IVCM supported diagnosis when PCR results were inconclusive and guided treatment cessation. Case two involved a 66-year-old keratoconus patient on immunosuppression for psoriasis who developed post-surgical fungal keratitis; IVCM differentiated immune-mediated response from fungal infection and directed antifungal treatment. Case three involved a 64-year-old woman with Sjögren's syndrome and long-standing dry eye disease refractory to prior treatments, where IVCM identified early immune changes in the sub-basal corneal nerve plexus that supported prescribing allogeneic serum eyedrops. The authors conclude that IVCM is a valuable non-invasive tool for improving diagnostic precision and enabling treatment adjustments in complex corneal cases.
